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Objective More than 80% of people with multiple sclerosis (MS) are affected by spasticity. Spasticity is known to reduce quality of life and contribute to additional symptoms, such as pain and reduced mobility, but the association between spasticity, balance, and mobility has not yet been established. Our aim was to examine whether a relationship exists between spasticity in the lower limbs, balance, and gait, as well as to explore the involvement of different muscle groups. Methods This study employed a cross‐sectional design. Thirty patients with MS were included. The Modified Ashworth Scale (MAS) was used to examine spasticity in the ankle plantar flexors, knee extensors, and hip adductors. Balance was measured using the Mini‐Balance Evaluation Systems Test, and gait with the 2‐Minute Walk Test. The participants were tested once with no additional follow‐up. Spearman's correlation, recursive partitioning, and linear regression analyses were used to explore the association. Results A significant correlation between gait distance and spasticity in the ankle plantar flexors (ρ = −.69, p < .001) and knee extensors (ρ = −.45, p = .012) was observed. Balance significantly correlated with spasticity in ankle plantar flexors (ρ = −.69, p < .001), knee extensors (ρ = −.52, p = .003), and hip adductors (ρ = −.5, p = .005). The relationship between spasticity in ankle plantar flexors and hip adductors was significant, even from low levels of spasticity, whereas MAS score ≥ 2 was clinically correlated with a decrease in gait and balance function. Adjustments for sex, age, or years since diagnosis had only minor impact on the results. Conclusions This study indicates that spasticity in the lower limbs is clinically significantly associated with mobility in people with MS. © 2019 The Authors. Physiotherapy Research International Published by John Wiley & Sons Ltd This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License

This is the peer reviewed version of the following article: Stock, R., Thrane, G., Anke, A., Gjone, R. I., Askim, T. (2017). "Early versus late-applied constraint-induced movement therapy: A multisite, randomized controlled trial with a 12-month follow-up". Physiotherapy Research International 23(1):e1689, which has been published in final form at https://doi.org/10.1002/pri.1689 . This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. Background and Purpose: A direct comparison between the effects of constraint‐induced movement therapy (CIMT) applied early after stroke and that of CIMT applied in the chronic phase has not been conducted. This study aimed to compare the long‐term effects of CIMT applied 6 months after stroke with the results of CIMT applied within 28 days post‐stroke. Methods: This study was a single‐blinded, multicentre, randomized controlled trial with a crossover design. Forty‐seven patients received CIMT either early (within 28 days) or 6 months after stroke. Both groups received standard rehabilitation and were tested at 5 time points. The primary outcome measure was Wolf Motor Function Test (WMFT); the secondary measures were Nine‐Hole Peg Test (NHPT), the Fugl‐Meyer Assessment (FMA) of the upper extremity, Stroke Impact Scale, and Modified Rankin Scale (MRS). Results: Compared with baseline data, both groups showed significant improvements in the primary and secondary outcome measures after 12 months. No significant differences between the 2 treatment groups were found before and after the delayed intervention group received CIMT at 6 months and during the 12‐month follow‐up. Both groups recovered considerably and showed only minor impairment (median FMA score of 64) after 6 months. The early intervention group showed an initially faster recovery curve of WMFT, NHPT, and MRS scores. Discussion: In contrast to most CIMT studies, our study could not find an effect of CIMT applied 6 months after stroke. Our results indicate that commencing CIMT early is as good as delayed intervention in the long term, specifically in this group of patients who might have reached a ceiling effect during the first 6 months after stroke. Nevertheless, the early CIMT intervention group showed a faster recovery curve than the delayed intervention group, which can be a clinically important finding for patients in the acute phase.